Alabama Nurse - November 2020

November, December 2020, January 2021 Alabama Nurse • Page 17
9-tetrahydrocannabinol (THC) and CBD use for the
treatment of several chronic pain conditions, after the
Italian government approved the use of cannabis for
legalized use for treatment. A specific pain modality
of oral ingestion was the focus, as it was noted that this
was the primary treatment prescribed by practitioners.
Results revealed that THC and CBD were effective in
treating chronic pain, but noted that many patients still
continued using their previously prescribed treatment.
This would suggest that THC and CBD would be a
successful adjunct therapy versus a standalone treatment.
In 2016, a Canadian study was completed and
published in the Journal of Pain Research by Ko,
G.D., Bober, S. L., Mindra, S., and Moreau, J. M., that
reviewed the barriers and concerns of THC and CBD use
in the Canadian healthcare system for the treatment of
chronic pain. A systematic review of available research,
discussed cannabis, concerns for its use, legalization,
prescribing methods, social concerns, availability of
various preparations of cannabis, and medical cannabis
regulations effecting or influencing Canadian citizens
utilizing THC and CBD preparations from a prescribing
practitioner. The authors came to the conclusion
that with education and evidenced based treatment
approaches, practitioners can safely and effectively
utilize cannabis, THC, and CBD for the treatment of
pain and reduce the use of narcotics.
In November of 2018, “unlicensed cannabis based
products” were able to be prescribed in the United
Kingdom, as cited in a systematic review completed
by Freeman, T. P., Hindocha, C., Green, S. F., &
Bloomfield, M. A. P. Six available products authorized
in the United Kingdom, were compared based upon
prescribing standards, licensed indications, and
authorized prescribers. Authors wanted to provide
education and discuss the various implications
associated with the six drugs with emphasis on use in
the United Kingdom, but noted considerations and some
comparisons with other developed countries. Much
discussion was provided on legal considerations and
variation in products, revealing minimal standardization
requirements for those products sold over the counter.
Results noted that cannabis, THC, and CBD are being
used for the treatment of chronic pain, with varying
degrees of success as cited in 14 studies with a total
of 2978 participants involving a singular prescribed
commercial product containing a combination of THC
and CBD (Sativex).
An interesting, yet very limited research study,
completed by David Keifer in 2017, demonstrated the
usefulness of a topical cannabis (a combination of THC
and CBD) for the treatment of pain in three patients
with gangrene. Traditional treatments, opioids, and
combinations therapies, had demonstrated little benefit
to the patients, so Keifer opted for a non-conventional
approach experimenting with new products. Results were
found to be significant in two of the three participants,
with other benefits noted to be reduced opioid use in two
patients. This study was small, but could possibly lead
the way for further controlled studies.
The majority of studies reviewed, strongly suggested
and encouraged the completion of more randomized
clinical trials to be completed distinguishing the effects
of THC versus CBD versus other active components
of cannabis to demonstrate the best combination
for treatment modalities. Several authors noted that
due to legal considerations and regulations in many
countries, randomized trials and research were difficult
to complete. It was felt that without further study, no
conclusive dosage, preparation, combination therapy,
or evidence could be finalized that best supported the
individual patient or treatment of chronic pain.
Discussion
There is evidence to support that CBD oil is an
effective treatment for chronic pain in adults, however
not enough was found to support it as a standalone
treatment. Most research has been on CBD oil combined
with another oil, therapy, or substance, or used in
combination with a different treatment regimen. This
leads to the evidence more strongly supporting CBD oil
as an adjunct therapy for chronic pain in adults.
CBD oil is available in various forms, including
lotions, creams, oils, food products, vaporized oils, and
oral pharmaceutical variations. There is currently no
standardized dosage or one size fits all recommended
amount of CBD oil to use topically, orally, or vaporized.
CBD oil is extracted from the hemp plant (Cannabis
sativa L). You will not find two identical plants, thus the
CBD oil extracted can have various amounts of THC
present and other constituents. A limiting factor is if
too much THC is present in extracted CBD oil, then it
cannot be sold legally in many states or countries, for it
would be considered marijuana. This would limit who
could or would study it.
Another consideration that still requires further
study is the influence of individual human factors and
variations on plant factors that can greatly influence
or deter the potential benefits of CBD oil. Groups of
individuals that participated in the current research
were chosen based upon a single disease or condition
predominately. Considerations for human factors such
as weight, genetics, metabolism, plant factors such as
environment, climate, or processing factors such as
inconsistent manufacturing practices or processes that
go into creating a CBD product were not addressed, thus
further limiting support.
Due to CBD oil popularity and “newness,” charlatans
and opportunistic salesmen are promoting CBD curealls
with little or questionable research available for
the average person. CBD is proudly advertised at the
local drug store, video store, health food chain, and it
continues to pop up all over the country. The promise
of miraculous cures, and healing properties from CBD
infused foods, body products, oils, and numerous other
creations, pique the curiosity of the average consumer,
and offer hope to the chronic pain sufferer. Yet the
science does not support these products and research is
still in its early stages predominately due to legal issues
surrounding the THC portion of the Cannabis sativa L
plant.
According to GOVERNING, as of June 25, 2019, in
the United States, the District of Columbia and 11 states
have passed laws into place that legalize marijuana
for recreational use. In the past ten years, the United
States and many countries, have seen a trend and felt the
push, by citizens and consumers, to legalize marijuana
and make it available for use by the common man for
self-medication and recreation. Prior to this, research
on CBD oil was very difficult to complete because it
came from the same “illegal” plant known as marijuana,
thus was not readily available for study and did not have
the funding sources needed to complete studies that
would be respected and well received by the medical
community.
To sum things up, CBD oil is promising. It has been
found to help relieve pain, and various other chronic
symptoms in smaller studies for different types of
chronic pain in adults. When combined with THC or
used as a supportive therapy to an already established
treatment, it has proven to be beneficial in helping
to diminish pain and improve the functionality and
quality of life in adults with chronic pain. It is worth
consideration for further study to examine its benefits in
larger adult studies, as a standalone treatment, as well as
a combination treatment. Once this has been completed,
hopefully a standardized dosing system or usage will
be approved by the Food and Drug Administration for
use to in adults to provide relief for chronic pain in its
many forms. Hope for an improved quality of life with
less pain is a possibility through the use of CBD oil for
adults with chronic pain.
Conclusions
Alternative medicine is still a new and developing
concept to westernized medicine practitioners, but it
is making head way in being accepted as a possible
treatment for chronic conditions, including adult pain
syndromes. With the legalization of marijuana in several
states in the United States, and several countries, the use
of CBD oil, THC, and cannabis has been a focus in the
medical community and public. CBD oil is considered
generally safe as an alternative treatment therapy which
has promoted its use.
CBD oil is generally combined with THC or cannabis
as an alternative treatment modality. Many participants
in current studies would continue current treatments
during the trialed CBD oil and THC or cannabis
combined therapy. So, it is unclear if the CBD oil and
THC or cannabis combined therapy worked well on
its own or had a positive or complementary effect on
the current westernized treatment already in progress.
The use of a combination therapy of administered
CBD oil and THC shows great promise as an effective
therapy for chronic pain. However, further research
needs to be completed to support the CBD oil/THC
combined therapy due to a low number of participants
and lack of standardized oils, dosages, and methods
of administration. The legal aspects still surrounding
marijuana in many countries and states, also greatly
limits research. CBD oil is indeed promising, but at
this time, the thesis that Cannabidiol (CBD) oil is an
CBD Oil continued on page 19